Preventing Older Adult

Falls:
Understanding Risk
Factors & Best Practices

Healthy Aging Partnership

May 26, 2009
Sally York MN, RNC
NorthWest Orthopaedic Institute
Tacoma, WA

Falls in Older Adults

20% - 30% fear falling1
35%-40% of people 65+ fall each
year2
Those who fall are 2-3 times more
likely to fall again3
10%-20% of falls cause serious
injuries4
1. Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002
2. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys
Med &
Rehab, 2001
3. Tinetti, New Eng J Med, 1988; Teno, JAGS,1990
4. Sterling, J Trauma-Inj Infection & Critical Care, 2001

Fall Injuries in Older Adults

Up to 20-30% of falls in older adults result in
an injury requiring medical care
Most fractures in Medicare population are due
to falls
Falls in older adults are the leading cause of
traumatic brain injury
Men have a higher rate of fatal falls (due to
TBI)
Women are more likely to have non-fatal falls
CDC Falls Among Older Adults: An Overview (2009)
www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Fall Risk Factors in Older

Adults
1. Chronic health
conditions
2. Physical and
functional
impairments
3. Medication and
alcohol use
4. Environmental
hazards

Primary Fall Risk Factor

Concepts
Assess & identify intrinsic (internal) risk factors
Examples- Age, osteporosis, vision loss, dementia
Assess & identify extrinsic (external) risk
factors:
Examples- Medications, footwear, assistive
devices, environment
Assess & identify acquired risk factors:
Examples- Facility or hospital admission due to
health change or decline (new environment),
delirium due to illness, increased disability due to
injury

Secondary Fall Risk

Concepts
Identify modifiable risk factors
Examples: Muscle weakness, poor balance,
exercise level, medications, environmental
lighting, footwear
Identify non-modifiable risk factors
Examples: Age, chronic conditions, disability,
dementia, vision loss

Goal Individual will modify (reduce)

modifiable risk factors

Falls Are Usually

Multifactorial
Intrinsic
Factors
Age changes

Chronic
conditions

Extrinsic
Factors
related

FALLS

Medications
Footwear
Alcohol
Environmental
factors

LE weakness

Acquired
Factors

Assistive device

American Geriatrics Society:

Most Common Intrinsic Fall Risk
Factors
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Muscle weakness
History of falls
Gait deficit
Balance deficit
Assistive device use
Visual deficit
Arthritis
Impaired Activities of Daily Living
Depression
Cognitive Impairment
Age >80 years

American Geriatrics Society (2001), Guideline for the Preventionof

Falls in Older Persons, JAGS, 49:664-672.

Modifiable Intrinsic
Risk Factors
Relative Risk

Muscle weakness
4.4 x
Gait & balance problems
2.9 x
Vision problems
2.5 x
Psychoactive medications
1.7
x
2001 American Geriatric Society Clinical Guidelines for the Prevention
of Falls, JAGS

ABCs of Why Older Adults Fall

Usually >1 Risk Factor Causes a Fall
1. Age, ambulatory status, assistive
device use
2. Balance, behavior at time of fall
3. Chronic conditions, cognitive
deficits
4. Drugs
5. Exercise level, environment
6. Footwear & flooring

CDC Fall Prevention

Recommendations: the 4
Pearls

Regular exercise
Medication review
Vision exams
Home safety evaluation

Fall Prevention Best Practices:

Multi-component Programs
Combine > 2 Best Practices

1.
2.
3.
4.
5.
6.
7.
8.

Individual risk assessment

Regular strength & balance exercise
Gait & assistive device training
Medication review & management
Management of chronic conditions
Vision correction
Education
Home safety improvements

WA State Dept. of Health, Falls Among Older Adults: Strategies for

Prevention (2002)
Centers for Disease Control

Best Practices for Older Adults

from Recent Clinical Studies
1. Clinical assessment & risk reduction
2. Exercise to improve balance, gait,
strength, endurance, & flexibility
3. Medication management: especially
benzodiazepines, antidepressants,
sedatives/hypnotics
4. Multi-component programs
Rubenstein et al, Handbook of Injury & Violence Prevention, 2007

Recommendations for Communitydwelling Older Adults (excl. those with

dementia):
Cochrane Review of 111 Studies (2009)
1. Exercise:
-multiple component (strength,
balance, aerobic) group classes
-Tai Chi
-home programs in adults without
severe impairments
2. Multifactorial interventions,
delivered by multidisciplinary teams
Gillespie et al, Cochrane Review: Interventions for preventing
falls in older people living in the community, April 2009

Summary
Risk factors, best practices & effective
interventions have been identified for
community-dwelling older adults after many
years of research
Injury prevention is an important goal in
populations at high risk for falls
Comprehensive prevention plans/programs that
include individual risk assessment &
individualized multi-component/multi-faceted
intervention approaches are the most effective
in reducing falls & fall risks

Thank You